For this assignment, you will revisit The Case of Marie. You will assess the needs of all relevant family members and work out treatment goals that will best

The Case of Marie

Marie is 68 years old and is part Scottish and American Indian. She lives in a town that provides a sense of security for her because she lives close to her two daughters. Before her move she lived in the same little rural town for the majority of her adult life.

She started out working for others but in her late 30s, she decided to stop and open her own business instead. That business was very successful but required long hours and hard work. She derived a sense of accomplishment from her business that could not be matched at any time in her life. She loved the interaction with others but could no longer keep up with the physical demands from the business. She retired 3 years ago. Marie is not wealthy but is capable of maintaining her home and lifestyle. She reports that now that she is retired she likes to read and feels most comfortable in her own home.

She currently reports feeling like she has no purpose. About 5 years ago her best friend and husband died of cancer. She and her husband had been married for 47 years at the time of his passing. She was profoundly shaken by this loss. Upon assessing her living arrangements at the time of his death, decisions were made in consultation with her two children to sell the business and move closer to her daughters. The move has had a positive and negative impact – positive due to being around others who care for her and negative due to the stress of being around young children. She reports becoming depressed and anxious around the anniversary date of her husband’s death.

Marie has two children. Lisa who has just turned 50 and Toni who is in her mid 40s. Both Lisa and Toni have young children of their own. Lisa is a single mother by choice with twins who are 4 years of age. Toni is married and has one child who is 5. Both of Marie’s daughters live close by and visit often. When they visit, Marie complains that the children make her stressed and tired. Lisa and Toni are concerned about their mother’s inability to tolerate the activity of the children. They want their mother to enjoy her grandchildren as much as possible.

Lisa is dependent on pain medication due to an injury that she encountered at work several years ago. She still functions fully as far as work and social life. She has challenges with her twins and yells at them frequently, to the point where one of the children is beginning to yell back at her and become defiant. She frequently asks for assistance from Marie with the children. The preschool has reported that this same child is having difficulty with social relationships and emotional connections but reports no negative behavioral issues.

Toni lives with her husband of 10 years and her daughter who is 5 years of age. Marie reports that Toni is supportive of her and provides emotional support when needed. Toni has been caring for her mother during the medical procedure that has been recently conducted.

Marie has just recently undergone an extensive knee replacement and is in physical therapy to regain her mobility. She has been taking prescription drugs for pain but refuses to take them as directed by the physician due to her experience with Lisa. She takes the pain medication only if she is in debilitating pain. Marie often reports having difficulty with her memory because she has to check on things more often, such as closing the garage door when she leaves, locking the door before bed, etc. She is extremely concerned about losing her cognitive abilities.

Toni has privately asked for your help in looking for an assisted living facility for Marie; she believes her mother is having increasing difficulty living on her own and doesn't feel she can provide consistent aid. She also thinks her sister is taking advantage of Marie's availability to watch her children. Lisa has privately urged you to convince her mother to start taking her pain medication, as well as asking you to help explain to Marie how beneficial it is for children to have a grandparent involved in their lives. Marie has recently told you that she thinks Lisa may have taken an unopened bottle of her pain medicine.

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Licensed under a Creative Commons Attribution 3.0 License.

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Kiara Bonds

SWK5007

Capella University

Dr. Robyn

5/18/2024

Ethical Dilemma in the Case of Marie

The ethical dilemma in the case of Marie involves balancing her autonomy with her need for care and managing the conflicting desires of her daughters, Lisa and Toni. Autonomy is central to the dilemma, as Marie is a woman who wishes to stay independent despite the troubles of her age and a recent knee replacement surgery. Toni would love to have her mother live in a nursing home as she thinks Marie is just becoming less and less able to be independent, and Toni can't be there regularly enough to help her out. Meanwhile, Lisa was trying to keep her mother active with her grandkids and taking her medicine for pain, which Marie feared would make her as dependent as Lisa. Marie further believed that Lisa was stealing her prescription medication for pain relief, and this added another layer of difficulty to the ethical issues at hand. This case further emphasizes the ambiguity of the lines between autonomy of Marie, ensuring her best interest, and safety versus the dynamics within the family and any issues of substance abuse that may be ongoing(Marie, 2023).

NASW Essential Steps for Ethical Problem-Solving

The NASW Code of Ethics lays out core steps for ethical problem-solving relevant to resolving the dilemmas in Marie's case. It is essential to distinctly identify the ethical issues; for example, the conflict is between the autonomy and safety of Marie and the potential substance abuse by Lisa. The second step would be to consider the core values and principles, which include respect for the dignity and worth of Marie as a human being and respect for the importance of relationships among people (Hadler et al., 2023). The third is considering relevant laws and policies, including laws on elder care and substance abuse treatment (Wogen & Restrepo, 2020). The fourth step is to identify possible actions that may be taken, for example, providing more in-home support to Marie or moving her to an assisted living facility. The fifth step is consultation with colleagues and experts. The healthcare providers and social workers need a diversity of perspectives and insights. The sixth step is to make decisions and clearly document the accountability process. The seventh and final step is monitoring and evaluating the outcomes, assessing Marie's situation with time to adjust the care plan if necessary. Such potential consequences at every stage run the gamut from the possibility of Marie becoming even less healthy if her independence is preserved at all costs without the proper support to negatively affecting her emotions by removing her from her home and placing her in assisted living.

Personal Values and Biases Impacting Decision-Making

Personal values and biases can have immense influence on the decision-making process in Marie's case. For instance, the autonomy value of a social worker may cause them to dwell on the fact that Marie is independent and thus overlook that she requires care with a more guided approach. One's biases toward Lisa could easily cause one to judge or even not attend to the right issues amicably. Further, cultural and personal beliefs on family obligations might inform suggestions on involving Marie regarding her grandchildren. To counter such values and biases, self-reflection process needs to be applied to always assess and challenge one's values and biases (Biidabinikwe & Cram, 2021). One should also be encouraged to seek supervision and consultation from peers to get other opinions and offset his or her own biases. Following the NASW Code of Ethics as a guide for actions and decisions is probably a key to objectivity and fairness that would ensure ethical decisions for all parties involved (Kesen et al., 2021).

Data Collection Methods for Ethical Decision-Making

Data collection underpins the effective, responsible, and ethical decision-making process in the case of Marie. Comprehensive client interviews with Marie, Lisa, and Toni are important in understanding worldviews and concerns related to each of them. Information gathered by Marie's healthcare providers about her physical and cognitive health forms a factual basis for evaluating her needs and risks. Home visits will establish firsthand observation of the safety and well-being of Marie and the family dynamics about living conditions. Checking with the preschool for any information about Lisa's children's behaviors would help assess the broader impacts of the family dynamic on the children. They ensure a thorough understanding of the situation, balancing risks with benefits. It also provide fact-based support for all recommendations and interventions, ensuring relevant support for ethical and effective decision-making.

Strengths, Needs, and Challenges in the Family System

In relation to the above-mentioned ethical issue, there are different strengths, needs, and challenges that can be identified within Marie's family. One of the strengths is that her family is closely knit; her children stay within the same vicinity and therefore represent an opportunity for an additional support network that could work well in her favor if utilized for her care. Another strength is that the family is tied closely through the involvement and emotional care for Marie by Toni. But there are also big demands, including Marie's need for structured support since her physical and mental health may deteriorate. Another necessity for change is the need for Lisa to improve her parenting difficulties and over-reliance on the taking of painkillers, in order to bring better dynamics within the family.

All the challenges are to ensure Marie's safety and balance with her freedom, to manage the different perspectives of Toni and Lisa in Marie's care, and to balance Marie's own autonomy with her care needs. The children added another new layer of complexity to the impact of parenting issues on Lisa. Some recommendations on reducing some of the struggles include hiring in-home support services to help keep Marie independent and safe, involving the family in counseling to overcome communication issues, and to unify them toward a single goal of care for Marie, and engaging Lisa in breaking free from the medication and faulty strategies for parenting. All the above steps are taken in order to capitalize on the family's strengths, meet their needs, work through the challenges, and strive forward to create a supporting and ethical atmosphere for Marie and her family.

Conclusion

Marie's case is rife with moral dilemmas between family issues and personal biases. Applying the NASW Code of Ethics creates principled resolutions to the concerns, ensuring that all decisions are made in the best interests. There are key practices to keep ethical standards in practice and uphold a supportive atmosphere for Marie and her family: continuous reflection of self, professional consultation, and thorough data collection. By balancing the exercise of autonomy with that of care for the person of Marie and further addressing family dynamics and possible substance abuse issues, the social worker promotes ethical and effective decision-making toward the well-being and dignity of all involved.

References

Biidabinikwe, E. T. ‐, & Cram, A. (2021). Who puts the value in Evaluation? There is a need for self‐reflection and transparency in advocacy and policy change evaluation. New Directions for Evaluation, 2021(171), 83–94. https://doi.org/10.1002/ev.20475

Hadler, R. A., Weeks, S., Rosa, W. E., Choate, S., Goldshore, M., Julião, M., Mergler, B., Nelson, J., Soodalter, J., Zhuang, C., & Harvey Max Chochinov. (2023). Top Ten Tips Palliative Care Clinicians Should Know About Dignity-Conserving Practice. Journal of Palliative Medicine. https://doi.org/10.1089/jpm.2023.0544

Kesen, N. F., Başer, D., Daşbaş, S., & Dziegielewski, S. F. (2021). Ethical Difficulties among Turkish Social Workers. Journal of Social Service Research, 1–13. https://doi.org/10.1080/01488376.2021.1889736

Marie, G., Stacy. (2023). Parents’ Perspectives of the Effectiveness of Family Treatment Court – ProQuest. Www.proquest.com. https://www.proquest.com/openview/53f685b00d69169564264ee86d518048/1?pq-origsite=gscholar&cbl=18750&diss=y

Wogen, J., & Restrepo, M. T. (2020). Human Rights, Stigma, and Substance Use. Health and Human Rights, 22(1), 51–60. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348456/

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